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Ng CA, Luckett T, Mulhern B, Kee D, Lai-Kwon J, Joshua AM. What matters most to people with metastatic uveal melanoma? A qualitative study to inform future measurement of health-related quality of life. Melanoma Res 2024; 34:248-257. [PMID: 38469755 PMCID: PMC11045555 DOI: 10.1097/cmr.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024]
Abstract
Metastatic uveal melanoma (mUM) is a rare cancer with poor prognosis, but novel treatments are emerging. Currently, there are no mUM-specific health-related quality of life (HRQL) questionnaires available for clinical research. We aimed to explore how mUM and its treatment affect HRQL and assess the content validity of existing questionnaires. Participants were patients with mUM and healthcare professionals involved in their care. Qualitative data were collected using semi-structured interviews and focus groups. Data collection and analysis used an integrative approach involving inductive questions/coding to elicit new concepts and deductive questions/coding based on domains of existing HRQL questionnaires. Initial interviews/focus groups focussed on HRQL questionnaires designed for patients with uveal melanoma or liver metastases. As new concepts were elicited, domains and items from other questionnaires were subsequently added. Seventeen patients and 16 clinicians participated. HRQL concerns assessed by uveal melanoma-specific questionnaires were largely resolved by the time of metastasis. The Functional Assessment of Cancer Therapy - Immunotherapy Module (FACT-ICM) adequately captured most immunotherapy-related side effects during initial treatment cycles. However, most patients emphasised emotional impacts over physical ones, focussing on the existential threat posed by disease amidst uncertainty about treatment accessibility and effectiveness. Patients were also concerned with treatment burden, including time commitment, travel, need for hospitalisation, and expenses. The relative importance of HRQL issues varied over time and across treatment modalities, with no single questionnaire being sufficient. Pending further development and psychometric testing, clinical researchers may need to take a modular approach to measuring the HRQL impacts of mUM.
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Affiliation(s)
- Carrie-Anne Ng
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, NSW
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney
| | - Damien Kee
- Department of Medical Oncology, Austin Health
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
- Melanoma Institute Australia, The University of Sydney
| | - Anthony M. Joshua
- Melanoma Institute Australia, The University of Sydney
- The Kinghorn Cancer Centre, Saint Vincent’s Hospital, Darlinghurst, NSW, Australia
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2
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Reinhardt ME, Sun T, Pan CX, Schmults CD, Lee EH, Waldman AB. A systematic review of patient-reported outcome measures for advanced skin cancer patients. Arch Dermatol Res 2023; 315:1473-1480. [PMID: 36469125 DOI: 10.1007/s00403-022-02479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Many patient-reported outcome measures (PROMs) have been used to study quality of life (QOL) in the skin cancer population. Advanced melanoma and non-melanoma skin cancer (NMSC) may be associated with increased morbidity, mortality, and treatment side effects; however, it is unclear which PROM is valid and appropriate to use in these populations for both clinical and research purposes. We aimed to identify the PROMs that have been used to measure QOL in advanced skin cancer patients and determine which of these PROMs have been validated to assess QOL outcomes in this population. A PubMed and EMBASE search was conducted from its inception to March 2021 according to PRISMA guidelines with a comprehensive list of search terms under three main topics: (1) PROM; (2) advanced skin cancer; and (3) staging and interventions. We included articles utilizing a PROM measuring QOL and having a patient population with advanced skin cancer defined as melanoma stage > T1a or non-melanoma AJCC stage T3 or greater. Advanced skin cancer patients were also defined as those with metastasis or requiring adjuvant therapy (systemic chemotherapy, radiation, and immunotherapy). Studies were excluded according to the following criteria: mix of low-risk and advanced skin cancer patients in the study population without stratification into low-risk and advanced groups, stage T1a melanoma or mix of stages without stratification, low-risk NMSC, no PROM (i.e., study specific questionnaires), non-English publication, review article or protocol paper, conference abstract, or populations including non-skin cancers. A total of 1,998 articles were identified. 82 met our inclusion criteria resulting in 22 PROMs: five generic health-related (QWB-SA, AQoL-8D, EQ-5D, SF-36, and PRISM), six general cancer (EORTC QLQ-C30, EORTC QLQ-C36, LASA, IOC, Rotterdam Symptom Checklist, and FACT-G), nine disease-focused or specialized (EORTC QLQ-H&N35, EORTC QLQ-MEL38, EORTC QLQ-BR23, Facial Disability Index, FACT-H&N, FACT-BRM, FACT-B, FACT-M, and scqolit), and two general dermatology (Skindex-16 and DLQI) PROMs. All PROMs have been generally validated except for EORTC QLQ-MEL38. Only two PROMs have been validated in the advanced melanoma population: FACT-M and EORTC QLQ-C36. No PROMS have been validated in the advanced NMSC population. The PROMs that were validated in the advanced melanoma population do not include QOL issues unique to advanced skin tumors such as odor, bleeding, itching, wound care burden, and public embarrassment. Breast cancer and head and neck cancer instruments were adapted but not validated for use in the advanced skin cancer population due to the lack of an adequate instrument for this population. This study highlights the need for PROM instrument validation or creation specifically geared toward the advanced skin cancer population. Future studies should aim to develop and validate a PROM to assess QOL in this population.
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Affiliation(s)
- Myrna Eliann Reinhardt
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA.
| | - Tiffany Sun
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | | | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | - Erica H Lee
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Abigail B Waldman
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
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Karakok H, Bostanci S, Akay BN, Calıskan D, Ateş C, Köse K. Validation of the Turkish Version of the Skin Cancer Quality of Life Impact Tool (SCQOLIT): A Health-Related Quality of Life Questionnaire for Non-metastatic Melanoma and Non-melanoma Skin Cancer. Dermatol Pract Concept 2023; 13:dpc.1301a1. [PMID: 36892383 PMCID: PMC9946060 DOI: 10.5826/dpc.1301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Skin cancer is the third most common type of cancer worldwide that has increased in incidence. Quality of life (QoL) instruments have been developed to measure the efficacy of treatments of cancers.
Objectives: The only validated tool that can be used in both nonmetastatic skin cancer types is the SCQOLIT. This study aimed to validate the Turkish version of the Skin Cancer Quality of Life Impact Tool (SCQOLIT).
Methods: A total of 141 patients diagnosed and treated for skin cancer within the previous 3 months were included. The tool was translated into Turkish in accordance with International Translation Guidelines. The Dermatology Quality of Life Index that was used for external validation. Patient demographics were recorded.
Results: Question 3 had a factor load of 0.372, indicating the inadequacy of this question in predicting QoL, a point that the original study did not mention. The SCQOLIT had external validity, convergent validity and internal consistency (Cronbach alpha=0.863), and test-repeat-test correlation coefficient was 0.824 (95% confidence interval; 0.644 – 0.918). Patients diagnosed with melanoma had poorer QoL scores. High-risk tumor characteristics in nonmelanoma skin cancer and stage of melanoma had no impact on QoL (p=0.235 for basal cell carcinoma, p=1.00 for squamous cell carcinoma, p=0.635 for melanoma).
Conclusions: The Turkish version of the SCQOLIT is validated. Age was shown to have a statistically significant negative correlation with QoL, while Fitzpatrick skin type, gender, risk classification, stage, history of skin cancer, family history of skin cancer and treatment modality had no effect on QoL.
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Affiliation(s)
- Hilayda Karakok
- Sifa Okulu, Private Practice Office of Dermatology and Venereology, Ataturk Bulvarı, Tasbası Mahallesi, Altınordu - Ordu, Turkey
| | - Seher Bostanci
- Department of Dermatology and Venereology, Ankara University School of Medicine, Turkey
| | - Bengu Nisa Akay
- Department of Dermatology and Venereology, Ankara University School of Medicine, Turkey
| | - Deniz Calıskan
- Department of Public Health, Ankara University School of Medicine, Turkey
| | - Can Ateş
- Department of Biostatistics, Van Yüzüncü Yıl University, School of Medicine
| | - Kenan Köse
- Department of Biostatistics, Ankara University School of Medicine, Turkey
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4
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Chen C, Wang Z, Qin Y. Health-related quality of life in stage III-IV melanoma treated with targeted therapy or immunotherapy: A systematic review on the adequacy of reporting and clinical issues in phase III randomized controlled trials. Cancer Med 2022; 12:2262-2280. [PMID: 36030506 PMCID: PMC9939121 DOI: 10.1002/cam4.5183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/09/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
Cutaneous melanoma represents around over 90% of all melanoma. With more effective treatments able to extend patients' survival, health-related quality of life (HRQOL) is increasingly becoming an important endpoint in cancer clinical trials. They are often secondary outcomes measured in phase III randomized controlled trials and their implementation, collection, analysis, and reporting can be challenging methodologically. For these reasons, an increasing number of international recommendations introduced the standards regarding the conduct of HRQOL. In this systematic review, we appraise the adequacy of HRQOL reporting in phase III randomized controlled trials of stage III-IV cutaneous melanoma and the clinical issues of immunotherapy and small-molecular-targeted therapy on HRQOL. Our search strategy totally got 55 articles, and only 13 studies met all inclusion criteria. Findings suggest that most treatments did not yield significant improvements in HRQOL but kept baseline levels, accompanied by prolonged survival and acceptable toxicity. Except for some existing limitations, reporting of HRQOL has made encouraging progress during the period covered by our search, but some aspects still need further optimization.
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Affiliation(s)
- Chen Chen
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina,Cancer Institute, University College LondonLondonUK
| | - Zehua Wang
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yan‐Ru Qin
- Department of OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Assessment of the perceived burden associated with Malignant Melanoma with Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28). Support Care Cancer 2022; 30:3643-3653. [PMID: 35032200 PMCID: PMC8857156 DOI: 10.1007/s00520-021-06760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The impact of malignant melanoma (MM) on patients' psychophysical well-being has been poorly addressed. We aimed to assess the perceived burden in patients with a diagnosis of MM, using two different tools, one generic and one specific for MM, such as Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28), respectively. The correlation between PRISM and MCQ-28 subscales and the relevance of disease and patient-related variables were also investigated. METHODS This single-centre, cross-sectional study included all adult consecutive MM patients who attended our Dermatology Unit from December 2020 to June 2021. Demographics and disease-related data were recorded. PRISM and MCQ-28 were administered. RESULTS One hundred and seventy-one patients were included (mean age: 59.5 ±14.9 years.; 48.0% males). Median time from MM diagnosis to inclusion was 36 months. Nearly 80% of the patients had in situ or stage I MM. Overall, 22.2% of the patients reported a PRISM score <100mm and similar percentages provided scores indicating impaired quality of life, as assessed with MCQ-28 subscales. A weak, albeit significant, correlation was found between PRISM scores and ACP, CON and SOC2 subscales. The most relevant association found was that between lower PRISM scores and higher-stage MM. CONCLUSIONS In the study population, mostly affected with superficial MM, their perception of the burden associated with MM did not appear either particularly dramatic or disabling. PRISM seems a reliable system for capturing and quantifying the domains correlated with the emotive dimension of MM, especially MM-related concerns and willingness to face life.
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Coen O, Corrie P, Marshall H, Plummer R, Ottensmeier C, Hook J, Bell S, Sagoo GS, Meads D, Bestall J, Velikova G, Gallagher FA, Smith A, Howard H, Mason E, Katona E, Silva S, Collinson M, Rodwell S, Danson S. The DANTE trial protocol: a randomised phase III trial to evaluate the Duration of ANti-PD-1 monoclonal antibody Treatment in patients with metastatic mElanoma. BMC Cancer 2021; 21:761. [PMID: 34210290 PMCID: PMC8246129 DOI: 10.1186/s12885-021-08509-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunotherapy is revolutionising the treatment of patients diagnosed with melanoma and other cancers. The first immune checkpoint inhibitor, ipilimumab (targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)), showed a survival advantage over standard chemotherapy. Subsequently the anti-programmed cell death protein 1 (PD-1) antibodies, nivolumab and pembrolizumab were shown to be more effective than ipilimumab. Ipilimumab combined with nivolumab gives an incremental gain in overall survival compared with nivolumab alone but increases the risk of severe, potentially life-threatening toxicities. In contrast to ipilimumab monotherapy, anti-PD-1 antibodies are licensed to be continued until disease progression. Follow-up of patients recruited to the first trials evaluating 2 years of pembrolizumab showed that three-quarters of responding patients continue responding after stopping treatment. Suggestive of early response, we hypothesised that continuing anti-PD-1 treatment beyond 1 year in progression-free patients may be unnecessary and so designed the DANTE trial. METHODS DANTE is a multicentre, randomised, phase III, non-inferiority trial to evaluate the duration of anti-PD-1 therapy in patients with metastatic (unresectable stage III and stage IV) melanoma. It uses a two-stage recruitment strategy, registering patients before they complete 1 year of first-line anti-PD-1 +/- CTLA-4 therapy and randomising eligible patients who have received 12 months of treatment and are progression-free at 1 year. At randomisation, 1208 patients are assigned (1:1) to either 1) continue anti-PD-1 treatment until disease progression/ unacceptable toxicity/ for at least 2 years in the absence of disease progression/ unacceptable toxicity or 2) to stop treatment. Randomisation stratifies for baseline prognostic factors. The primary outcome is progression-free survival at 3, 6, 9 and 12 months and then, 6-monthly for up to 4-years. Secondary outcomes collected at all timepoints include overall survival, response-rate and duration and safety, with quality of life and cost-effectiveness outcomes collected 3-monthly for up to 18-months. Sub-studies include a qualitative analysis of patient acceptance of randomisation and sample collection to inform future translational studies into response/ toxicity biomarkers. DISCUSSION DANTE is a unique prospective trial investigating the optimal duration of anti-PD-1 therapy in metastatic melanoma patients. Outcomes will inform future use of these high burden drugs. TRIAL REGISTRATION ISRCTN15837212 , 31 July 2018.
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Affiliation(s)
- Oliver Coen
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Marshall
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | | | - Jane Hook
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Bell
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | | | | | - Galina Velikova
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Leeds Institute of Medical Research at St James's University Hospital, Leeds, UK
| | - Ferdia A Gallagher
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Alexandra Smith
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Helen Howard
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Ellen Mason
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Eszter Katona
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Shobha Silva
- Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Michelle Collinson
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Simon Rodwell
- University of Sheffield, Sheffield, UK
- Melanoma Focus, Cambridge, UK
| | - Sarah Danson
- Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK.
- University of Sheffield, Sheffield, UK.
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7
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Lisy K, Lai-Kwon J, Ward A, Sandhu S, Kasparian NA, Winstanley J, Boyle F, Gyorki D, Lacey K, Bishop J, Jefford M. Patient-reported outcomes in melanoma survivors at 1, 3 and 5 years post-diagnosis: a population-based cross-sectional study. Qual Life Res 2020; 29:2021-2027. [PMID: 32140919 DOI: 10.1007/s11136-020-02464-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a lack of population-based data describing patient reported outcomes (PROs) in melanoma survivors which could guide the development of interventions and resources. This study assessed overall quality of life (QoL), self-reported symptoms and unmet information needs in melanoma survivors 1, 3 or 5 years post-diagnosis. METHODS A cross-sectional postal survey was conducted in Victoria, Australia, with eligible melanoma survivors identified from a population-based cancer registry. Patient-reported outcome measures included the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and self-reported symptoms, difficulties and information needs. Associations between demographic, disease and care-related factors and QoL were also assessed. RESULTS A total of 476 melanoma survivors participated in the study (response rate 46.5%). Anxiety and depressive symptoms were more prevalent in survivors compared to the general population (30.7% vs 21.6%; p < 0.01). Fear of cancer recurrence (48.3%) and fear of cancer spreading (37.8%) were the most commonly reported symptom items, and approximately one in five melanoma survivors had unmet information needs related to psychological aspects of living with melanoma. Recurrent melanoma, living in a nursing home, chronic comorbidities, and melanoma diagnosed at > 2 mm thickness were associated with lower QoL. CONCLUSION A large proportion of melanoma survivors reported ongoing quality of life deficits, fear of cancer recurrence, as well as unmet information needs up to 5 years after diagnosis. Patients may benefit from tailored informational resources and interventions that address the psychological aspects of living with and beyond melanoma.
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Affiliation(s)
- Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Andrew Ward
- The Social Research Centre, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and the Developing Mind, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julie Winstanley
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, The Mater Hospital, University of Sydney, Sydney, NSW, Australia
| | - David Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Karen Lacey
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Jim Bishop
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, a Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Winstanley J, White E, Saw R, Young T, Burmeister B, Nikolic D, Busto-Cornide I, Iglesias-Pena N, Boyle F. Development of the Melanoma Concerns Questionnaire (MCQ-28); refinement of the EORTC QLQ-MEL38 module. Psychooncology 2019; 29:321-330. [PMID: 31652387 DOI: 10.1002/pon.5251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/23/2019] [Accepted: 09/29/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Few patient-reported outcome measures (PROMs) have been developed that adequately measure the patient-experience following diagnosis and treatment of melanoma. Building on previous research, which developed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Module (QLQ-MEL38), the aim of this study was to further test the hypothesised domain structure and psychometric properties of the phase 3 module, in a new larger sample of melanoma patients. METHODS Melanoma patients (n = 270) were recruited from four countries (Australia, England, Serbia, and Spain). Patients completed the EORTC core questionnaire (QLQ-C30), the QLQ-MEL38, and a sociodemographic survey. Using this new larger dataset, comparisons were made with the hypothesised domain structure of the EORTC phase 3 module using principal component analysis. Items which formed subscales in a revised domain structure were then tested for goodness of fit (GoF) to the Rasch model. RESULTS The original hypothesised and final domain structures were similar but not identical. Twenty-four items (83%) loaded onto the same distinct subscales previously generated by phase 3, and item-by-item comparison of the two pattern matrices indicated an extremely close match. Ten items were removed from the QLQ-MEL38 phase 3 module, and rescoring of some items was required. Four subscales, together with five individual items, comprised the final instrument. CONCLUSION The newly developed measure (named the Melanoma Concerns Questionnaire; MCQ-28) was found to tap into several important psychosocial domains of concern to melanoma patients, particularly those being managed in "usual" clinic settings.
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Affiliation(s)
- Julie Winstanley
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia.,White Winstanley Ltd, Cheshire, UK
| | - Edward White
- White Winstanley Ltd, Cheshire, UK.,School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Robyn Saw
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | - Teresa Young
- East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, UK
| | | | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,University Hospital Medical Center Bezanijska kosa, Belgrade, Serbia
| | | | | | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia.,Melanoma Institute Australia, University of Sydney, Sydney, Australia
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9
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Lai-Kwon J, Khoo C, Lo S, Milne D, Mohamed M, Raleigh J, Smith K, Lisy K, Sandhu S, Jefford M. The survivorship experience for patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors. J Cancer Surviv 2019; 13:503-511. [PMID: 31165342 DOI: 10.1007/s11764-019-00770-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) and BRAF and MEK inhibitors (BMi) have improved survival in metastatic melanoma (MM). However, the experience of long-term responders remains undescribed. This study characterised survivorship issues faced by long-term responders to ICI or BMi. METHODS Patients with MM, aged ≥ 18 years old, ≥ 6 months post-ICI or BMi initiation with an objective response or stable disease. A 72-question survey assessed physical and psychological effects, impact on lifestyle, access to information, satisfaction with care, and availability of supports. RESULTS One hundred and five of 120 (88%) patients completed the survey (ICI 69/BMI 36). For the ICI cohort, 39 (57%) were receiving ongoing treatment, 17 ceased due to toxicity and 13 due to a sustained response. For the BMi cohort, 31 (85%) were receiving ongoing treatment, 4 ceased due to toxicity and 1 due to a sustained complete response. At data cut-off on 18 December 2018, median PFS (range) was 2.5 years (1.3-8.5) for ICI and 3.1 years (0.6-7.3) for BMi. Long-term toxicities included dry/itchy skin (ICI 51, 74%/ BMi 25, 69%), arthralgias (ICI 30, 58%/ BMi 23, 64%) and fatigue (ICI 62, 90%/ BMi 33, 92%). Psychological morbidity was common, including anxiety awaiting results (ICI 50, 72%/ BMi 29, 81%), fear of melanoma recurring or progressing (ICI 56, 81%/ BMi 31, 86%) or death (ICI 44, 64%/ BMi 26, 72%). CONCLUSION MM survivors experience chronic treatment toxicities and frequently report psychological concerns. IMPLICATIONS FOR CANCER SURVIVORS Survivors may benefit from discussions regarding long-term toxicities and tailored psychological supports.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Chloe Khoo
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Research and Medical Consultations, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Donna Milne
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Mustafa Mohamed
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Jeanette Raleigh
- Research Division, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Kortnye Smith
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
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10
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Chernyshov PV, Lallas A, Tomas-Aragones L, Arenbergerova M, Samimi M, Manolache L, Svensson A, Marron SE, Sampogna F, Spillekom-vanKoulil S, Bewley A, Forsea AM, Jemec GB, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in skin cancer patients: literature review and position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer. J Eur Acad Dermatol Venereol 2019; 33:816-827. [PMID: 30963614 DOI: 10.1111/jdv.15487] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer (NMSC) present a review of the literature and position statement on health-related (HR) QoL assessment in skin cancer patients. A literature search was carried out to identify publications since 1980 that included information about the impact of SC on QoL. Generic, dermatology-specific, cancer-specific, SC-specific, facial SC-specific, NMSC-specific, basal cell carcinoma-specific and melanoma-specific QoL questionnaires have been used to assess HRQoL in SC patients. HRQoL was assessed in the context of creation and validation of the HRQoL instruments, clinical trials, comparison of QoL in SC and other cancers, other diseases or controls, HRQoL assessment after treatment, comorbidities, behaviour modification, predictors of QoL and survival, supportive care needs, coping strategies and fear of cancer recurrence. The most widely used instruments for HRQoL assessment in SC patients are the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), Skin Cancer Index (SCI), Short Form 36 Item Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI). The TFs recommend the use of the cancer-specific EORTC QLQ-C30, especially in late stages of disease, and the melanoma-specific FACT-M and SC-specific SCI questionnaires. These instruments have been well validated and used in several studies. Other HRQoL instruments, also with good basic validation, are not currently recommended because the experience of their use is too limited. Dermatology-specific HRQoL instruments can be used to assess the impact of skin-related problems in SC. The TFs encourage further studies to validate HRQoL instruments for use in different stages of SC, in order to allow more detailed practical recommendations on HRQoL assessment in SC.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Samimi
- Dermatology Department, University of Tours, Tours, France
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - S Spillekom-vanKoulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - A M Forsea
- Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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11
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Makady A, Kalf RRJ, Ryll B, Spurrier G, de Boer A, Hillege H, Klungel OH, Goettsch W. Social media as a tool for assessing patient perspectives on quality of life in metastatic melanoma: a feasibility study. Health Qual Life Outcomes 2018; 16:222. [PMID: 30497502 PMCID: PMC6267816 DOI: 10.1186/s12955-018-1047-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/13/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Development of innovative drugs for melanoma is occurring rapidly. Incremental gains in overall survival amongst innovative products may be difficult to measure in clinical trials, and their use may be associated with increased toxicity profiles. Therefore, HTA agencies increasingly require information on HRQoL for the assessment of such drugs. This study explored the feasibility of social media to assess patient perspectives on HRQoL in melanoma, and whether current cancer- and melanoma-specific HRQoL questionnaires represent these perspectives. Methods A survey was distributed on the social media channels of Melanoma Patient Network Europe to assess melanoma patients’ perspectives regarding HRQoL. Two researchers independently conducted content analysis to identify key themes, which were subsequently compared to questions from one current cancer-specific and two melanoma-specific HRQoL questionnaires (i.e. EORTC QLQ-C30, EORTC QLQ-MEL38, FACT-M). Results In total, 72 patients and 17 carers completed the survey. Patients indicated that family, having a normal life, and enjoying life were the three most important aspects of HRQoL for them. Carers indicated that being capable, having manageable adverse events, and being pain-free were the three most important aspects of HRQoL for patients. Respondents seem to find some questions from HRQoL questionnaires relevant (e.g. ‘Have you felt able to carry on with things as normal?’) and others less relevant (e.g. ‘Have you had swelling near your melanoma site?’). Additionally, wording may differ between patients and HRQoL questionnaires, whereby patients generally use a more positive tone. Conclusions Social media may provide a valuable tool in assessing patient perspectives regarding HRQoL. However, differences seem to emerge between patient and carer perspectives. Additionally, patient perspectives did not seem to fully correlate to questions posed in cancer- (i.e. EORTC QLQ-C30) and melanoma-specific (i.e. EORTC QLQ-MEL38, FACT-M) HRQoL questionnaires examined. Electronic supplementary material The online version of this article (10.1186/s12955-018-1047-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amr Makady
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands. .,Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands.
| | - Rachel R J Kalf
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands
| | - Bettina Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden.,Uppsala University, Uppsala, Sweden
| | | | - Anthonius de Boer
- Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Olaf H Klungel
- Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
| | - Wim Goettsch
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
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12
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Dréno B, Ascierto PA, Atkinson V, Liszkay G, Maio M, Mandalà M, Demidov L, Stroyakovskiy D, Thomas L, de la Cruz-Merino L, Dutriaux C, Garbe C, Bartley K, Karagiannis T, Chang I, Rooney I, Koralek DO, Larkin J, McArthur GA, Ribas A. Health-related quality of life impact of cobimetinib in combination with vemurafenib in patients with advanced or metastatic BRAF V600 mutation-positive melanoma. Br J Cancer 2018; 118:777-784. [PMID: 29438370 PMCID: PMC5877437 DOI: 10.1038/bjc.2017.488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/22/2022] Open
Abstract
Background: In the coBRIM study, cobimetinib plus vemurafenib (C+V) significantly improved survival outcomes vs placebo and vemurafenib (P+V) in patients with advanced/metastatic BRAFV600-mutated melanoma. An analysis of health-related quality of life (HRQOL) from coBRIM is reported. Methods: Patients completing the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) at baseline and ⩾1 time point thereafter constituted the analysis population. Change from baseline ⩾10 points was considered clinically meaningful. Results: Mean baseline scores for all QLQ-C30 domains were similar between arms. Most on-treatment scores for QLQ-C30 domains were also comparable between arms. A transient deterioration in role function in cycle 1 day 15 (C1D15; -14.7 points) in the P+V arm and improvement in insomnia in the C+V arm at C2D15 (-12.4 points) was observed. Among patients who experienced a ⩾10-point change from baseline (responders), between-group differences were greatest for insomnia (16%), social functioning (10%), fatigue (9%) and pain (7%), all favouring C+V. Diarrhoea, photosensitivity reaction, pyrexia, and rash did not meaningfully affect global health status (GHS). Serous retinopathy was associated with a transient decrease in GHS at C1D15 assessment. Conclusions: In patients with advanced/metastatic BRAFV600-mutated melanoma, treatment with C+V maintained HRQOL compared with P+V, with superior efficacy.
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Affiliation(s)
- Brigitte Dréno
- Department of Dermato Cancerology, Nantes University, Nantes 44093, France
| | - Paolo A Ascierto
- Istituto Nazionale Tumori Fondazione G. Pascale, Naples 80131, Italy
| | | | | | - Michele Maio
- Azienda Ospedaliera Universitaria Senese, Siena 53100, Italy
| | - Mario Mandalà
- Department of Oncology and Haematology, Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Lev Demidov
- N. N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia
| | | | - Luc Thomas
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Pierre-Bénite 69495, France
| | | | | | - Claus Garbe
- Department of Dermatology, University of Tübingen, Tübingen 72074, Germany
| | | | | | - Ilsung Chang
- Genentech, Inc., South San Francisco, CA 94080, USA
| | | | | | - James Larkin
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.,University of Melbourne, Parkville, VIC 3052, Australia
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA
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13
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Quality of life assessment in patients with nonmelanoma skin cancer - psychometric validation of the EORTC QLQ-C30 questionnaire. J Dtsch Dermatol Ges 2017; 15:1090-1100. [DOI: 10.1111/ddg.13357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Karolina Müller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology; Klinikum Vest; Recklinghausen Germany
| | - Julia Steinbauer
- Dermatology Practice; Regensburger Straße 36a; 93133 Burglengenfeld Germany
| | - Elisabeth Kohl
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Dominik Steinbauer
- General Medicine Practice; Kallmünzer Straße 2; 93133 Burglengenfeld Germany
| | - Florian Zeman
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Michael Koller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
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14
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Beurteilung der Lebensqualität bei Patienten mit nicht-melanozytärem Hautkrebs - psychometrische Validierung des EORTC QLQ-C30-Fragebogens. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13357_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karolina Müller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Klinikum Vest, Recklinghausen; Deutschland
| | - Julia Steinbauer
- Dermatologische Praxis; Regensburger Straße 36a; 93133 Burglengenfeld Deutschland
| | - Elisabeth Kohl
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Dominik Steinbauer
- Allgemeinmedizinische Praxis; Kallmünzer Straße 2; 93133 Burglengenfeld Deutschland
| | - Florian Zeman
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Michael Koller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
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15
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Dunn J, Watson M, Aitken JF, Hyde MK. Systematic review of psychosocial outcomes for patients with advanced melanoma. Psychooncology 2016; 26:1722-1731. [PMID: 27696578 DOI: 10.1002/pon.4290] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND New advanced melanoma therapies are associated with improved survival; however, quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear. OBJECTIVE Synthesize qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients. METHODS Five databases were searched (01/01/1980 to 31/01/2016). Inclusion criteria were as follows: advanced melanoma patients or sub-group analysis; assessed psychosocial outcomes; and English language. RESULTS Fifty-two studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN-alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localized disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored, and no clear framework described coping/adjustment trajectories. Patients with advanced versus localized disease had more supportive care needs, particularly amount, quality, and timing of melanoma-related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non-representative sampling; and cross-sectional design. CONCLUSIONS Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial well-being. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focused attention.
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Affiliation(s)
- Jeff Dunn
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Social Science, The University of Queensland, St Lucia, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia
| | - Maggie Watson
- Pastoral and Psychological Care, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melissa K Hyde
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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